Why Nobody Believes the Numbers: Distinguishing Fact from Fiction in Population Health Management

As former Publisher of "Managed Healthcare Executive" and "Formulary" journals, I know Al Lewis is the real deal. Don't know whether anyone knows this industry better: Co-founding Disease Management (DM) industry and furthering it into Population Health Improvement (PHI) movement. After a few years' absence, I was surprised to see how much these cats had strayed.In the book, Al exposes and instructs so succinctly ... and so funny! And he keeps the solution simple: "It's just basic 5th grade math." His humor really leads. Gotta laugh.Al doesn't just attack from page one; he lays out what is being done and then shows what how it should be done. After these specifics on errant methods, he shows them in real case studies. He keeps it simple and on a progressive, additive track.For example, in the book, Al showed how the PHI industry boasts health cost savings of 200%, 300%, or more. Initially one is wowed by such stunningly big results. But then Al brings up the basic math about it. He points out that you can't cut anything by more than 100%. Duh! If I cut 100% of $100 then I'm cutting all of the spending. How do you cut 200% of anything?In another example from the book, Al Lewis points out how some in the industry use a pre/post comparison of cardiac event spending. Well, pre/post sounds reasonable so I'm hooked. Then Al takes us further into the actual data to reveal that they use 2 separate population segments: One for pre and one for post. Duh, again! That's insane! You have to measure the same population for pre as post.Lewis nails each one maize dead end."Why nobody believes the numbers" is not an overly serious book filled with industry-speak. But it very much is a valuable text book. With 20 years in health care I've seen a lot of them and this would rank up there with the very best for its reality, simplicity, and relevance. Even though Al's a professional numbers guy, he doesn't get reader bogged down -- only simple English and common sense. Nothing is more complicated than it needs to be.Because he spends so much time laying out each errant method upfront, I had no problem recognizing each one in the case studies. The facts of the case didn't get in the way of my seeing the point. But the case studies are necessary. I believe that by seeing the methods in case context, I will recognize them more easily.I recommend this book to anyone in the healthcare sector or wants to be. This should be a must-read text book in business schools, health professions schools, ... and middle school math classes.

A little difficult to beleive at first. The logic and reasoning makes sense though. I always question data when I see it. This is a good way to interpret outliers and look at information that is often misled/malinterpreted and simply overlooked.

Al Lewis managed to squeeze several categories of lessons into this book, all of which make it worth reading. Other reviews have extolled the virtues of Al's dive into wellness and DM so I'm going to focus on three benefits that I got from reading it, all of which are likely good reasons for you to read it.First, he forced me to realize that my statistical thinking had become very lazy. It wasn't that I was falling for statistics that could not pass a plausibility test but I had stopped thinking about why they didn't pass. A few chapters into this and I felt like my edge had been reset.Second, the book teaches a very simple lesson in business and life: it is not easy to deliver great results. The claims made by some of the DM companies are humorous but no more humorous than claims made by many companies in many industries. Let this be a lesson on similar chicanery going on all around us. The claims are similar to promises that led to truth in advertising yet we probably miss it more often than we see it.Finally, results do not happen overnight. Change takes time. It needs to be thought through, It costs money. It has to accommodate human behavior and differences. The Highmark, BlackBox and Quantum examples all support that simple conclusion but it is a conclusion that we often skip in favor of a 350% cost improvement in Year 1.I enjoyed the book and will recommend it within healthcare to make smarter buyers and users and outside of healthcare to give others an example of the kinds of examples they should be watching for in their own industries.

I started my career in the packaged goods industry and gained an appreciation for properly conducted research and its power to provide insight and drive better outcomes. I transitioned to health care and in 2009 worked with a company that developed behavior change programs, gaining broad exposure to providers of EAP and wellness programs.I naively assume there would be excellent research in this area-it is after all health care, right? Was I ever mistaken. For example, a leading provider of digitally delivered health and behavior change programs, purchased in 2008 by an east coast company (I will spare them the embarrassment)puts their research findings and cost savings claims on their website. When I reviewed their site as part of a SWOT analysis I was stunned. ANY competent statistician would have either laughed or shuddered. And they are a leader in the space!Mr. Lewis sheds light on this in a clear, usually easy to understand and always funny manner. He points out that HR is not up to the task of making the types of quantitative analyses necessary; that is why they are in HR! And the programs can work, and in some cases may be appropriate as tools to brand the employer. (As an aside, friends in the wellness and behavior change industry tell me there is incredible cost pressure on the suppliers. That is what happens when programs do not work, they commoditize)This book should be required reading for CFO's and those charged with selecting and approving health care for their firm.

Como estou escrevendo um pré-projeto de pesquisa para doutorado em saúde pública (avaliação dos resultados de um programa de saúde), o livro será muito útil, quase imprescindível. Mas acabou de chegar. Só li a introdução.